PMID- 31982992 OWN - NLM STAT- MEDLINE DCOM- 20210805 LR - 20210805 IS - 1612-9067 (Electronic) IS - 1612-9059 (Linking) VI - 17 IP - 3 DP - 2020 Jul TI - Clinical utility of salivary pepsin measurement in patients with proton pump inhibitor-refractory gastroesophageal reflux disease symptoms: a prospective comparative study. PG - 339-347 LID - 10.1007/s10388-020-00714-z [doi] AB - BACKGROUND: Salivary pepsin measurement has been reported to be useful for diagnosing gastroesophageal reflux disease (GERD). This study aimed to clarify the usefulness of salivary pepsin measurement in patients with proton pump inhibitor (PPI)-refractory GERD symptoms without erosive esophagitis. METHODS: One hundred and two patients were included. Over seven days after terminating PPI treatment, all patients underwent a 24-h pH-impedance test and salivary pepsin measurement. In patients whose main symptoms included laryngopharyngeal symptoms, a hypopharyngeal multichannel intraluminal impedance (HMII) test was performed, whereas in other patients, a conventional combined multichannel intraluminal impedance-pH (MII-pH) test was performed. In the HMII tests, patients were divided into abnormal proximal exposure (APE) and non-APE groups. Salivary pepsin concentrations were compared according to acid exposure time (AET) values and were also compared between the APE and non-APE groups. RESULTS: The median salivary pepsin concentration in patients with AET > 6% was significantly higher than that in patients with AET 109 ng/mL) to diagnose patients with AET > 6% were 75.0%, 51.3%, 32.1%, and 86.9%, respectively. There was no significant difference between concentrations in the APE group and concentrations in the non-APE group. CONCLUSIONS: In patients with PPI-refractory nonerosive reflux disease, salivary pepsin measurement may help diagnose patients who have conclusive evidence of reflux, whereas it is not adequate for identifying patients with APE. FAU - Matsumura, Tomoaki AU - Matsumura T AUID- ORCID: 0000-0001-5314-9325 AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. matsumura@chiba-u.jp. FAU - Arai, Makoto AU - Arai M AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Suzuki, Takeshi AU - Suzuki T AD - Department of Otorhinolaryngology, Head and Neck Surgery, Chiba University, Chiba, Japan. FAU - Hoppo, Toshitaka AU - Hoppo T AD - Esophageal and Lung Institute, Allegheny Health Network, 4815 Liberty Avenue, Mellon Pavilion, Suite 158, Pittsburgh, PA, 15224, USA. FAU - Seki, Yosuke AU - Seki Y AD - Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan. FAU - Kasamatsu, Shingo AU - Kasamatsu S AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Ishigami, Hideaki AU - Ishigami H AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Ishikawa, Kentaro AU - Ishikawa K AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Okimoto, Kenichiro AU - Okimoto K AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Akizue, Naoki AU - Akizue N AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Maruoka, Daisuke AU - Maruoka D AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Nakagawa, Tomoo AU - Nakagawa T AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. FAU - Odaka, Takeo AU - Odaka T AD - Odaka Medical and Gastrointestinal Clinic, Chiba, Japan. FAU - Okamoto, Yoshitaka AU - Okamoto Y AD - Department of Otorhinolaryngology, Head and Neck Surgery, Chiba University, Chiba, Japan. FAU - Kato, Naoya AU - Kato N AD - Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. LA - eng GR - 18K09367/Japan Society for the Promotion of Science/International PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200125 PL - Japan TA - Esophagus JT - Esophagus : official journal of the Japan Esophageal Society JID - 101206627 RN - 0 (Proton Pump Inhibitors) RN - EC 3.4.23.1 (Pepsin A) SB - IM MH - Adult MH - Aged MH - Drug Resistance MH - Electric Impedance MH - Esophageal pH Monitoring/methods MH - Female MH - Gastroesophageal Reflux/diagnosis/drug therapy/*metabolism MH - Humans MH - Hypopharynx/pathology MH - Laryngopharyngeal Reflux/diagnosis/epidemiology MH - Male MH - Middle Aged MH - Pepsin A/*analysis MH - Predictive Value of Tests MH - Prospective Studies MH - Proton Pump Inhibitors/*therapeutic use MH - Saliva/*metabolism MH - Sensitivity and Specificity OTO - NOTNLM OT - GERD OT - LPR OT - NERD OT - Ppi-refractory GERD OT - Salivary pepsin EDAT- 2020/01/27 06:00 MHDA- 2021/08/06 06:00 CRDT- 2020/01/27 06:00 PHST- 2019/08/02 00:00 [received] PHST- 2020/01/12 00:00 [accepted] PHST- 2020/01/27 06:00 [pubmed] PHST- 2021/08/06 06:00 [medline] PHST- 2020/01/27 06:00 [entrez] AID - 10.1007/s10388-020-00714-z [pii] AID - 10.1007/s10388-020-00714-z [doi] PST - ppublish SO - Esophagus. 2020 Jul;17(3):339-347. doi: 10.1007/s10388-020-00714-z. Epub 2020 Jan 25.